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低频重复经颅磁刺激治疗难治性癫痫患者的临床研究
癫痫是一种慢性脑部疾患,表现为因脑部神经元过度放电所致的突发、反复和短暂的中枢神经系统功能失常,常伴有脑电图(electroencephalogram,EEG)异常.
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早产儿振幅整合脑电图的背景活动
自20世纪60年代末Maynard等[1]首次使用脑功能监测(cerebral function monitor,CFM)以来,至今已有40多年.近年来,由CFM得出的振幅整合脑电图(amplitude integrated electroencephalogram,aEEG)在新生儿监护中的使用越来越广泛.该技术在新生儿重症监护病房(neonatal intensive care unit,NICU)的应用包括临床脑电活动的常规监测、癫痫活动检测和预后评估等.目前一些研究提供了不同胎龄或纠正胎龄早产儿aEEG的数据,以及早产儿aEEG的特征性表现,如波幅、连续性、睡眠-清醒周期(sleep-wake cycling,SWC)随胎龄或纠正胎龄(postmenstrual age,PMA)增加而出现的变化.目前多认为,脑电发育的特征主要与PMA有关,而与胎龄、出生后日龄、出生体重及其他生长发育指标没有绝对关系[2].施亿赟等[3]研究表明,正常足月新生儿的aEEG表现不受日龄、性别、分娩方式及母亲妊娠并发症的影响.另有研究表明,aEEG对新生儿惊厥监测的敏感性和特异性比较理想,与视频脑电图的分析结果有着很好的一致性[4].而对新生儿aEEG的分析很大程度上是以正常脑电图(electroencephalogram, EEG)从早产儿到足月儿变化的一般规律为基础的.基于此,本研究通过对早产儿脑功能监测结果的分析,初步探讨脑功能监测在早产儿的应用价值.
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The automatic detection and identification of electroencephalogram waves play an important role in the prediction, diagnosis and treatment of epileptic seizures. In this study, a nonlinear dynamics index-approximate entropy and a support vector machine that has strong generalization ability were applied to classify electroencephalogram signals at epileptic interictal and ictal periods. Our aim was to verify whether approximate entropy waves can be effectively applied to the automatic real-time detection of epilepsy in the electroencephalogram, and to explore its generalization ability as a classifier trained using a nonlinear dynamics index. Four patients presenting with partial epi-leptic seizures were included in this study. They were al diagnosed with neocortex localized epi-lepsy and epileptic foci were clearly observed by electroencephalogram. The electroencephalogram data form the four involved patients were segmented and the characteristic values of each segment, that is, the approximate entropy, were extracted. The support vector machine classifier was con-structed with the approximate entropy extracted from one epileptic case, and then electroence-phalogram waves of the other three cases were classified, reaching a 93.33%accuracy rate. Our findings suggest that the use of approximate entropy al ows the automatic real-time detection of electroencephalogram data in epileptic cases. The combination of approximate entropy and support vector machines shows good generalization ability for the classification of electroencephalogram signals for epilepsy.
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Although low-frequency repetitive transcranial magnetic simulation can potentially treat epilepsy, its underlying mechanism remains unclear. This study investigated the influence of low-frequency re-petitive transcranial magnetic simulation on changes in several nonlinear dynamic electroenceph-alographic parameters in rats with chronic epilepsy and explored the mechanism underlying repeti-tive transcranial magnetic simulation-induced antiepileptic effects. An epilepsy model was estab-lished using lithium-pilocarpine intraperitoneal injection into adult Sprague-Dawley rats, which were then treated with repetitive transcranial magnetic simulation for 7 consecutive days. Nonlinear elec-electroencephalographic parameters were obtained from the rats at 7, 14, and 28 days post-stimulation. Results showed significantly lower mean correlation-dimension and Kolmogo-rov-entropy values for stimulated rats than for non-stimulated rats. At 28 days, the complexity and point-wise correlation dimensional values were lower in stimulated rats. Low-frequency repetitive transcranial magnetic simulation has suppressive effects on electrical activity in epileptic rats, thus explaining its effectiveness in treating epilepsy.
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儿童脑电图
一、儿童脑电图的特征儿童脑电图(children's electroencephalogram)的特点主要是显示年龄的差异.儿童的脑部机能随着年龄的增长而不断完善,脑电图也不断成熟,儿童年龄阶段的不同,其脑波正常变化的范围也不同.因此在阅读儿童脑电图时,应特别注意年龄特点和生理上的变化.
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颅内(皮质、深部)脑电图
颅内脑电图(intracranial electroencephalogram,IEEG)主要包括术前侵入性评估,是指通过颅骨钻孔或立体定向仪把深部电极安放到脑的深部组织,如海马、杏仁核等部位,直接记录这些部位的脑电活动和通过颅骨钻孔或开颅手术,将条型或网络状电极安置在脑表面(硬膜外或硬膜下)记录脑各个不同部位的发作间期以及发作期的脑电活动.
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癫痫与睡眠相关性研究进展
早在一个多世纪以前,癫痫与睡眠的密切关系就已被认识.人们在对癫痫的研究中发现癫痫发作在时间分布上有一定的规律,特别是观察到癫痫发作易受睡眠觉醒周期的影响[1].近年来,随着细胞分子生物学的飞速进展,癫痫的发病机制也得到了深入研究,现已肯定癫痫的发作存在具有功能意义的昼夜生物节律性[2].借助动态脑电图(active electroencephalogram,AEEG)及多导睡眠图(polysomnogram,PSG)的协助诊断,对癫痫与睡眠相互关系的研究目前正逐步进展,现综述如下.
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大田原综合征手术治疗1例
1 临床资料患儿,女,11月,因"反复发作性四肢强直10个月"入院.患儿于出生后24 d出现发作性四肢强直,频繁发作,在当地儿童医院诊断为"大田原综合征".6个月后出现发作性点头,伴双上肢拥抱样动作,呈簇性发作,行脑电图(electroencephalogram,EEG)检查提示高幅失律.曾在多家医院接受正规抗癫痫药物治疗[包括丙戊酸钠、托吡酯、氯硝西泮、加巴喷丁、奥卡西平及促肾上腺皮质激素(adreno-cortico-tropic-hormone,ACTH)]和生酮饮食疗法未见明显好转,现仍表现为强直性发作和点头发作,每天发作20~50次.家属反映其精神发育迟滞.
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振幅整合脑电图在新生儿监护中的应用
近年来,由脑功能监护仪(Cerebral function monitor,CFM)记录得出的振幅整合脑电图(amplitudeintegrated electroencephalogram,aEEG)在新生儿监护中的应用逐渐增多.该理论是以过滤压缩的脑电图为基础,通过相对简便的阅图分析,得出脑电背景活动在一段时期内的趋势和变化,以指导对临床预后的判断.自上世纪60年代Maynard等应用首台脑功能监护仪持续监测脑电活动起,aEEG在临床上的应用已有40多年历史.